MEDICARE: MISS HIBA HAMMAD AL TAQ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	32179	OK
2	207R00000X	Internal Medicine Physician	R0724	TX

General Provider Information

NPI Number	:	1689932352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS HIBA HAMMAD AL TAQ MD

Provider Business Mailing Address
First Line	:	1533 SADIE CREEK RD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-2411
Country	:	US
Telephone Number	:	716-342-5929
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 STANTON L YOUNG BLVD # 8400
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5018
Country	:	US
Telephone Number	:	405-271-6173
Fax Number	:	405-271-5892

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2012
Last Update Date	:	05/20/2021

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